Pigtail Catheter Chest Drainage System is Cost-Effective for Traumatic Hemothorax

Percutaneous pigtail catheter chest drainage (PCCD) is safe and effective for stable traumatic hemothorax (HTX), but its economic value relative to standard interventions remains undefined. We hypothesized that PCCD is a cost-effective alternative to standard tube thoracostomy (TT) and evaluated this using a decision-tree cost-effectiveness model.

A Monte Carlo microsimulation model evaluated 10,000 simulated cases of hemodynamically stable adults presenting with isolated traumatic HTX. We randomized cases to PCCD (≤14 French) or standard TT (>14 French). Using literature-derived parameters for costs, quality-adjusted life-years (QALYs), and conversion to video-assisted thoracoscopic surgery, we compared costs and QALYs from a US payer perspective over a 30-d time horizon. We weighted health state utilities by time spent in each state to yield QALYs. We set the willingness-to-pay threshold at $100,000/QALY.

PCCD was the dominant strategy, costing $930 less per case and providing an incremental benefit of 0.0015 QALYs compared with standard TT. Because PCCD was both less costly and more effective, we report no incremental cost-effectiveness ratio. In probabilistic sensitivity analysis, PCCD was the optimal strategy in 93.1% of iterations at willingness-to-pay of $100,000/QALY and was the less costly strategy in 99.8% of iterations. The model was most sensitive to the rate of conversion to video-assisted thoracoscopic surgery and considerably less sensitive to device costs; PCCD remained cost-effective whenever its conversion rate was at or below that of standard TT.

In this model, PCCD was cost-saving relative to standard TT with a small advantage in effectiveness, though both differences were modest and PCCD was favored in 93.1% of probabilistic iterations. These findings support PCCD as an economically reasonable option for hemodynamically stable adults with traumatic HTX in centers where operator experience permits, but they are not sufficient on their own to justify a change in practice standards. Future prospective studies should evaluate real-world economic outcomes to validate these modeled findings.